We provide a multi-factorial long-term follow-up following minimal invasive direct coronary artery bypass grafting (MIDCABG) to evaluate the long-term efficacy. From 1996 onwards, 390 patients underwent MIDCABG (follow-up: 30.0+/-11.2 months). We analyzed peri-operative and postoperative complications (<30 days) and we obtained early and late angiography. Cumulative follow-up was 1000 patient-years. Early postoperative mortality was 0.8% and myocardial infarction occurred in 1.3% of all patients. Early postoperative angiography (<30 days) was obtained in 238 patients (66.3%) and revealed patency in 97.5% (232/238) including 211 (88.6%) who had no stenosis, 13 with a <50% stenosis (5.5%) and 8 with a >50% stenosis (3.4%), but a patent graft. Only six patients had a total occlusion (2.5%). In the long-term follow-up (completed 74.6%; 291/390 patients), the overall mortality was 5.8%, whereas only 1.7% died due to cardiac reasons. Myocardial infarction occurred in 3.0%, redo CABG was necessary in 1.3%. Seventy-eight patients had late postoperative angiography (>30 days) of those 93.6% (n=73) had a patent graft: 58 had no stenosis (74.4%), 4 had a <50% stenosis (5.1%) and 11 had a >50% stenosis (14.1%), but a patent graft. Only in five patients (6.4%) the anastomosis was occluded. MIDCABG is a safe procedure with long-term anastomotic patency rates comparable with those of open-chest LIMA-left-anterior descending artery (LAD) bypass.